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Sometimes there is no quick fix for a dental problem and you may be one of those unfortunate people that suffers from multiple issues with the same irritating tooth. You may have undergone a number of different treatments but the pain still remains and now your dentist is recommending an apicoectomy in order to save the infected tooth.

What is an Apicoectomy?

If an apicoectomy has been suggested by your dentist, then it means that your tooth cannot be successfully treated with the conventional root canal treatment. An apicoectomy is a minor surgical procedure performed by an endodontist in which the very tip of the tooth’s root is removed and sealed. The word “apicoectomy” literally means ‘end removal’. An endodontist is a dentist that specializes in the diagnosis and treatment of tooth pain from root canal disease and they are highly skilled at performing this type of surgical procedure.

Traditional Root Canal Treatment

Inside the center of a tooth (the pulp chamber) there is living tissue that contains nerves, blood vessels and connective tissues that keep the tooth alive. Tiny roots or veins (typically three) branch out from the pulp chamber to the ends of the tooth creating a root canal system. Endodontic treatment, more commonly known as root canal treatment, is needed when the pulp chamber becomes inflamed or infected. There are several reasons why this can happen including:

deep tooth decay;

repeated dental procedures to fix a tooth (large fillings); or

tooth damage such as a crack, chip or even a fracture.

If the pulp dies from any of these causes, then the pulp chamber and canals also become infected. That infection can eventually spread into the surrounding bone and gum tissue around the tip of the root causing pain and discomfort.

Conventional root canal treatment involves drilling a small access hole into the pulp chamber through the bottom of the tooth. The Inflamed or infected tissue is then removed from the pulp chamber along with all root canals. The remaining space inside the tooth is then cleaned out, disinfected, filled, and sealed. A temporary or permanent filling material will then be placed over to cover the access hole. A permanent cap (crown) is often used to seal the access hole, replace lost tooth structure and to protect the tooth from biting stresses and further damage.

The success rate concerning the treatment of a root canal is over 95%. However, it is not 100% successful. For most people a tooth restored during a root canal could last a lifetime, as long as they continue to care for their teeth and gums. This treatment can typically be done by your dentist without the need for a specialist consultant and they may take x-rays in order to find all the root canals within the tooth. Endodontists also use radiographs or sometimes CBCT scans (cone beam-computed tomography) that create three-dimensional views in order to examine root canals and diagnose disease that might otherwise go undetected by ordinary practitioners.

If the Root Canal Treatment Fails

If you have previously undergone root canal treatment you will know that a lot of work goes into treating a root canal infection and it can take more than one visit to the dentist to have the treatment completed. For most people, the conventional root canal treatment is successful but root canals can become re-infected after treatment for a variety of reasons, such as:

new or recurrent decay;

previously undetected canals that remain sensitive; and,

calcification of canals (a blocking of the canals that prevents them from being fully cleaned by conventional root canal treatment). This is typically caused either due to age or after a trauma to the teeth.

In some situations the conventional root canal retreatment is not feasible as it may jeopardize the continued use of the tooth. For example, if a tooth already has a crown in place it may require taking apart the entire restoration to access the root canal, which could further weaken the tooth. Patients that suffer from failed root canal issues typically complain of sensitivity to heat and infrequent biting pain. In these cases, a better alternative is to treat the infected tooth from the root end of the tooth (without removing the crown) with an apicoectomy.

The Apicoectomy Process

An apicoectomy is a surgical approach through the gum rather than the visible tooth. The gum area will be thoroughly numbed with local anesthesia and then a small incision is made through the gum tissue. The incision will be made near the infected root, giving the endodontist direct access to the infected peri-apical tissue (the gum tissue directly touching the tooth). This direct approach allows for the removal of any inflamed or infected tissue around the tip of the root without the need to drill directly into the tooth. After removal, a very small filling is placed at the end of the root canal to seal the canal and prevent further infection. A endodontist will then secure the gum tissue with a few sutures (stitches) to ensure that it is closed and will heal properly. In rare cases, if the infection has left a significant void, bone grafting and other techniques are used to help the bone grow and fill back in. Now that the infection has been removed the area will heal and return to normal function after a reasonable healing period.

When performing endodontic surgery, endodontists use state-of-the-art technology such as fiber optic lights, operating microscopes, and ultrasonic instruments that clean via high frequency vibration. Although the surgery sounds complex and daunting to many patients, these advanced technologies give endodontists a very precise view of the tooth, making the treatment quick, comfortable and successful.

It can be a long road of treatments for unfortunate patients that have had conventional root canal treatment fail but an apicoectomy can save teeth that otherwise would have been extracted. Once performed the tooth, bone and gum tissues that were previously infected will return to health and functional use for many years.

(Summerville, SC) Each year, over 22.3 million endodontic procedures are performed in the United States. In the period between 1999 and 2006, these treatments increased by 10 percent, with this upward trend continuing past that point. Right now, 68 percent of all endodontic procedures are performed by general dentists, while 26 percent are handled by endodontists. This is a shocking statistic considering the importance of these treatments and the purpose they serve.

An endodontist is a root canal specialist, which means they have the custom training and equipment needed to ensure these procedures are done properly and reduce the potential for adverse consequences. To help raise awareness of services provided by endodontists, Charleston Endodontics has recently launched a new website offering information and resources regarding the treatment solutions provided.

“When you utilize our endodontic treatment, you can feel confident that your teeth will remain functional for years down the road,” stated company representative Gina Parks. “We know how to provide the needed root canal or other treatment to ensure it heals properly and that additional issues don’t arise. Unfortunately, this high level of skill and specialization isn’t something general dentists offer, even though they provide these treatments.”

“Right now, we offer our endodontic treatment services in four locations in South Carolina,” continued Parks. “Two of our offices are located in Charleston, with two more in Summerville. We hope or new website will explain some of the treatments we offer and why using our services is often the better option.”

With over 14 million root canal treatments performed annually, it is essential that consumers have information at their disposal to make decisions regarding who they receive service from. This reduces the potential of issues and ensures the patient fully understands the treatment they need.

ABOUT CHARLESTON ENDODONTICS

The professionals at Charleston Endodontics are all members of the American Association of Endodontists. Each service provider looks forward to providing the superior solutions and treatment patients need. The expert team, which is led by Drs. McAbee, Steinkruger, Wiggins, and King, ensures each person treated has a positive experience and receives the solutions they need for a healthy and beautiful smile.

Most people dread the thought of going to the dentist when they start to feel a small ache in their gums. That first sign of sensitivity can cause fear as we start to wonder what the underlying cause and implications will be. At some stage in our lives, most of us have experienced unwanted tooth pain which can be one of the most agonizing and stressful times for our bodies. A cracked tooth can start off as a small irritating sensitivity but left untreated, it can lead to extreme pain and tenderness which is easily prevented by a trip to the dentist.

What is Cracked Tooth Syndrome?

Cracked tooth syndrome (CTS) also known as cracked cusp syndrome or split tooth syndrome occurs when there is a crack in the tooth that is too small to show up on X-rays, or is under the gum. This can make CTS challenging to identify but it mostly appears on molars (the lower back teeth). This is because molars absorb most of the force when chewing.

People that grind or clench their teeth may be more likely to have cracked tooth syndrome due to the added force applied to the teeth. Another contributing factor can be the way a person’s teeth naturally come together which can put too much pressure on one specific tooth. This added pressure can cause the tooth to crack.

In many cases, teeth that have already been treated with large fillings may be more likely to crack. As are teeth that have undergone root canal treatment as they are weaker than the surrounding teeth and more susceptible to pressure. People with one cracked tooth are more likely to have others, either at the same time or in the future. Cracked tooth syndrome presents mainly in patients aged between 30 years and 50 years, in both men and women equally.

Signs of CTS

The first tell-tale sign of CTS will be that the tooth may hurt when you bite or chew. The pain can be mild or intense and it might be a fleeting sharp pain or last for a long time. In some patients it may be painful only when eating certain foods or when they bite in a specific way. There will not normally be a constant ache, as there would be for a cavity or abscess but the tooth may become more sensitive to cold temperatures.

If left untreated and the crack gets bigger, a piece of the tooth may break off. This could lead to an infection of the surrounding gum around the fractured tooth. A pimple-like bump might appear on the gum near the tooth which will need to be drained of pus by a dentist. This is known as a fistula and may require antibiotics to ensure that the infection fully clears.

Unfortunately, many people with cracked tooth syndrome can suffer with these symptoms for months as CTS is one of the most difficult dental problems to diagnose because the pain is not predictable. You may be referred to an endodontist (a root canal specialist) if your dentist is unable to make the diagnosis.

What to Expect During the Diagnosis

Like any normal visit, your dentist will examine your mouth and teeth, focusing on the tooth in question. They may use a sharp instrument called an explorer to feel for cracks in the tooth and check for any pain while biting. Your dentist will also look at the gums around the tooth and check for sensitivity. The dentist may wish to have X-rays taken but they do not often show the crack. In some cases, if the tooth already has a filling or crown, your dentist may remove it in order to see the visible crack underneath.

Treatment for CTS

A previously stated, it is difficult to get a confirmed diagnosis for CTS and there are a number of factors that affect the type of treatment available, such as:

Where on the tooth the crack is,

How deep it is, and

How large it is.

Sometimes a crack affects more than one part of the tooth and may be fixed with a crown (also known as a cap). Some cracks can affect the center of the tooth (the pulp), where the nerves and blood vessels are, and in these situations the tooth will need root canal treatment. Around 20% of cracked tooth syndrome cases will need root canals. After the root canal treatment, the tooth will no longer be sensitive to temperature but it will still respond to pressure, therefore the gum may still ache.

If the crack affects the root of the tooth in the jaw, then it will have to be removed. There is no other way to fix this type of crack and you can have the tooth replaced with an implant or bridge.

Prevention

If you are aware that you grind your teeth and you would like to prevent CTS, your dentist can make a night guard (a plastic bite piece) that you wear at night to relieve the pain from grinding. For some people, this will also stop tooth sensitivity and it can be worn at other times during the day if clenching or grinding is an issue.

It is also worth keeping a close eye on teeth that have already got crowns or root canals as they are more likely to crack than other teeth. Alert your dentist to any possible pain or sensitivity with specific teeth as soon as you become aware of the problem.

Your dentist will be able to talk you through all of your options whether it is a crown, root canal or extraction and possibly be able to prevent further issues with a night guard. Treatment of cracked tooth syndrome is not always successful. Unfortunately, some people continue to have occasional symptoms after treatment and they may require the help of a specialist.

If you believe you are suffering from CTS or think that grinding your teeth might cause CTS, speak to your dentist and arrange for a check-up at the earliest opportunity.